What this year’s celebration of World Breastfeeding Week is really about—more than updating the status on breastfeeding acceptance or increasing understanding for mothers who are unable to breastfeed—is advocacy for parent support.

While the primary goal of Attachment Parenting International (API) is to raise awareness of the importance of a secure parent-child attachment, the organization’s overarching strategy is to provide research-backed information in an environment of respect, empathy and compassion in order to support parents in making decisions for their families and to create support environments in their communities. API extends beyond attachment education, also promoting the best practices in all aspects of parenting from pregnancy and childbirth to infant feeding and nurturing touch to sleep and discipline to personal balance and self-improvement through such innovative programs as API Support Groups, the API Reads book club and the Journal of Attachment Parenting, just to name a few.

API is a parent support organization made up of parents located around the world with a deep desire to support other parents.

Parent Support Deserts

In this spirit, API created the Parent Support Deserts project through which we mapped gaps in local parent support opportunities specific to Attachment Parenting (AP). The goals of this multi-layered project are to identify communities, regions and nations in need of conscious-minded parent support and to encourage collaboration among like-minded organizations to address these gaps.

The first part of the project was identifying key nations of the world that we feel would ideally have organized, like-minded parent support options available. We focused on developed countries, because societal advance encourages separation from the natural world, including biologically instinctual ways of living and relating to one another, as is reflected in family structure and mainstream parenting philosophies. Industrialized nations lead the world in ideas and developing, and less-industrialized and underdeveloped nations tend look to these societies for guidance. We used the World Bank’s list of Developed Countries and Territories. All of the nations included in the project are defined as high-income economies as determined by Gross National Product, per-capita income, level of industrialization, widespread technological infrastructure and high standards of living.

The second part of the project was identifying key parent support organizations. We were looking for representative organizations with local support groups or classes with an approach to parent support that closely matches that of API—advocating for conscious, informed parenting choices that challenge the status quo:

Attachment Parenting International

Babywearing International

Holistic Moms Network

International Association of Infant Massage

International Cesarean Awareness Network

La Leche League International

Pathways Connect

API recognizes that there are myriad local parent support opportunities in many communities that are not affiliated with these key parent support organizations, such as peer counselors, professionals, groups and classes available through hospitals, clinics, faith-based organizations, schools, etc. and that some of these may be quality, AP-minded programs. We appreciate this and welcome these independent programs to nominate themselves for inclusion in the Parent Support Deserts project through rita@attachmentparenting.org.

We have a bias toward local support groups because the research validates the importance of a parenting support network. This may be provided through family, friends, coworkers and others in an informal way, but a community of like-minded parents is an empowering environment for parents learning about and growing in their parenting approach.

It is to be noted that not all communities identified as having a parent support option may have an active local support group at any one time, as some local leaders hold groups while others, depending on their own life stage or lack of interest from the community, opt not to lead a group but to remain available for one-on-one support. What was important in mapping communities was identifying those with an active parent support leader affiliated with one of the key parent support organizations who is either leading a group or class, or is available to provide support in this way should the interest from parents arise.

It is also to be noted that local support groups or classes unaffiliated with API may provide varying degrees of AP education that may or may not be aligned with API’s Eight Principles of Parenting. However, each of these representative organizations promote an environment that empowers parents in finding their own path for intentional parenting.

The third part of the project is dissecting each nation into both parent support deserts as well as oases. The first nation we are focusing on is the United States.

Future steps include cross-examining data according to risk factors such as areas with low breastfeeding rates, high infant mortality, high Cesarean rates and other aspects of public health, as well as creating maps to illustrate parent support deserts and oases, and inviting discussion among the AP community in how to address gaps in parent support.

Infant-Feeding Parent Support Deserts

Local parent support for breastfeeding has grown at an astonishing rate since La Leche League (LLL) International was founded in Illinois, USA, in 1956. LLL groups are located worldwide in nearly all developed nations as well as other less-developed countries. LLL has expanded its resources as cultures have evolved with technology and the changing roles for mothers, assisting mothers in providing breast milk to their infants whether through exclusive or partial breastfeeding or pumping as needed.

As research pours in on the benefits of breast milk and breastfeeding, evidence continues to point toward AP practices, such as using fewer interventions during childbirth, avoiding early mother-baby separation, rooming-in at the hospital, breastfeeding on demand, interpreting pre-cry hunger signals, encouraging skin-to-skin contact, room sharing, discouraging cry-it-out sleep training, helping the father in supporting the mother, and others. As a result, the vast support network that many communities now have for breastfeeding mothers—from a breastfeeding-friendly medical community to lactation consultants and peer counselors to doulas and childbirth educators and parent educators trained in lactation support—tend to direct breastfeeding mothers toward Attachment Parenting.

By contrast, there are few organized AP-minded support opportunities for mothers who are unable to or choose not to breastfeed or feed expressed breast milk. Formula-feeding parents are relatively on their own in terms of finding support that rightly points them in the direction of Attachment Parenting, as this choice or necessity to bottle-feed exclusively is seen less as part of the relationship context and more solely a nutritive option—though certainly we know, and research in sensitive responsiveness is finding, the behaviors surrounding bottle feeding are as much a part of the parent-child relationship as is breastfeeding. Unlike breastfeeding support, formula-feeding support is much less cohesive, with some information sources putting forth questionable science regarding formula versus breastfeeding benefits.

This gap in support provides an opportunity for API Support Groups and other like-minded organizations to offer acceptance, validation and support in AP practices to non-breastfeeding mothers. One program in the United States that does this is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), putting as much attention on formula-feeding mothers as those who choose to breastfeed.

For this introductory look at the Parent Support Deserts project, we examined locations of parent support groups in terms of infant-feeding in the Attachment Parenting context. We focused on LLL for breastfeeding support and API for both breastfeeding and formula-feeding support. Specifically, we were looking at:

Unsupported Key Communities = Communities of 100,000 or more, or state capitals, without either an LLL or an API presence.

Undersupported Key Communities = Communities of 100,000 or more, or state capitals, with either an LLL or an API presence, but not both.

Notable Communities = Communities of any population with both an API and LLL presence as well as other Attachment Parenting-minded support.

Key communities have a population of at least 100,000 or are state capital cities, because of these communities’ population density and centrality to policymaking and lawmaking.

We recognize that families in less-populated areas are as much in need of support. The Parent Support Desert project has found that LLL’s distribution worldwide and within the United States includes both urban and rural population centers, making LLL unique among like-minded organizations. API considers LLL to be an important partner in the Attachment Parenting movement, not only because of its representative size, reach and longevity but also because the parenting support provided in addition to breastfeeding education is directly in line with that promoted by API.

While this list is in flux, following are state reports of API’s Parent Support Deserts specific to Attachment Parenting infant-feeding support in the United States as spring 2014:

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

A mother on a mission can do amazing things, especially when working with an equally passionate parent support advocate.

Nancy Mohrbacher, a La Leche League (LLL) leader in Chicago, Illinois, USA, said it was a mother in her group who gave birth to an idea that has become the Mothers’ Milk Bank of the Western Great Lakes—one of a number of milk banks sprouting up around the world to serve mothers who are unable to breastfeed exclusively but no longer want to settle for formula.

“We need more milk banks to save more lives,” said Mohrbacher, IBCLC, FILCA, author of Breastfeeding Answers Made Simple, and chair of the board of directors for the now-developing Mothers’ Milk Bank. “And this seems to be an idea whose time has come because many are springing up all over.”

The mother in Mohrbacher’s LLL group gave birth to a preterm boy, and the hospital staff insisted that he receive formula because he was too weak to exclusively nurse. The mother knew about the lifesaving and life-giving properties of breast milk, and she knew about the potential negative outcomes of feeding formula to a preterm baby. She told Mohrbacher that she would have preferred to feed her baby donor breast milk.

This mother went on to ask Mohrbacher to help her start a milk bank for the Chicago and Wisconsin areas—a region with one of the highest infant mortality rates in the United States and for which a formal recommendation was made by the Wisconsin Neonatal Perinatal Quality Collaboration that low-birth-weight babies be fed pasteurized donor breast milk, rather than formula, when the mother’s own milk is not available.

For those families who have healthy babies, but for some reason the mother was unable to breastfeed, milk banks can meet their needs as well, provided that critically ill and preterm infants have been helped first.

The preterm baby in Mohrbacher’s group had a milder condition than other babies who are admitted to hospital neonatal intensive care units for care, and he is now nursing well despite formula supplementation. But for very preterm or more severely ill babies, anything other than human milk can cause serious health problems, like necrotizing enterocolitis (NEC), which occurs when a part of a baby’s intestines becomes inflamed and dies. The treatments for NEC account for 19% of all newborn health care costs. When NEC requires surgery, half of the babies treated die, and many of those who survive suffer from lifelong disabilities. Breast milk helps prevent NEC.

According to a 2009 study (Quigley, M. et al. “Formula milk versus donor breast milk for feeding preterm or low birth weight infants”), small preterm babies fed infant formula are two-and-a-half times more likely to develop NEC than those fed pasteurized donor human milk. The components unique to human milk prevent the inflammation that causes NEC, among other complications. Even partial human milk feedings are much less likely to cause a baby to become seriously ill.

“Human milk is preventative medicine for these babies,” Mohrbacher said.

With the advances in medical technology, more preterm infants are able to survive outside the womb. Since premature delivery and medical complications can reduce a mother’s milk supply despite her best efforts, more donor human milk is needed. Despite the life-saving properties of breast milk, the price per ounce for donor milk ranges from $3.50 to $4.50, and a prescription is required. Part of the expense stems from the pasteurization process, which is essential for preterm babies, as any pathogens in the milk could make an already sick or unstable infant more ill.

“Because the cost of collecting, processing and distributing pasteurized donor human milk is so high, even selling milk at cost puts it out of reach financially for most families,” Mohrbacher said. “A healthy 1-month-old usually takes between 25 and 30 ounces per day. Preterm babies need far less milk, [but] the health risks of infant formula are much greater for them.”

In general, the cost of feeding a premature baby donor breast milk in the hospital is shifted to the hospital itself, government programs and insurance companies. After a critically ill baby leaves the hospital and a family can no longer afford pasteurized human milk, the charitable arm of a nonprofit milk bank will often reach out to supply these families with the milk that will protect their babies.

Mohrbacher and her coworkers have assembled a team of experts to find a facility, buy equipment and begin processing donor milk for their region. They estimate that they will need approximately $1 million to open their processing facility and establish the charitable arm of the milk bank. Within three years of opening, they predict, the $4.50 per ounce that hospitals pay for human milk will allow their bank to become financially self-sustaining.

As Mohrbacher and the Mothers’ Milk Bank prove, you do not have to be famous or rich or powerful to make a difference. Any caring individual, with proper help and funding, can establish a nonprofit milk bank. The Mothers’ Milk Bank are first and foremost a group of people who care about saving infants’ lives and are determined to help those infants survive and thrive.

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

When a woman makes the choice to breastfeed, she usually doesn’t anticipate that it won’t work. After all, we are told that almost everyone can breastfeed—and this is true: Lactation is a robust biological process that almost always works.

But though there are only a few medical conditions in which breastfeeding may be limited, there are many medical circumstances that can present lactation and feeding challenges. Mothers who wean early for medical reasons or who are never able to breastfeed at all suffer a loss and may experience a spectrum of emotions that range from disappointment, frustration and anger to guilt, sadness and grief to relief and acceptance.

Editor’s Note: The description of certain medical conditions and breastfeeding recommendations contained in this article are specific to individual cases. It is not advice. Contact your health care provider for medical advice on these or other conditions. Contact an International Board-Certified Lactation Consultant (IBCLC), La Leche League (LLL) Leader or another breastfeeding specialist for more information regarding breastfeeding concerns in your individual case.

A Heartrending Choice

Kim Barbaro of Warminster, Pennsylvania, USA, faced the difficult choice of weaning when she developed a breast abscess that required surgery. Her surgeon explained that the incision would be long and deep, extending into the areola, and would remain open for some time, requiring packing twice a day.

Kim says that while her doctor gave her facts about the surgery, she was also understanding and empathetic: “She absolutely left the decision up to me,” she said. “But she didn’t just talk about the medicine; she talked about the bonding and the quality of time and being a working mom, and that really pulled me to her. It was that level of compassion and understanding that made a gigantic difference.”

“At first I was just confused, definitely torn between two worlds,” Kim added. “I think one of the biggest things for me was that bonding piece [with the baby], because it is so strong, and I didn’t want to be without it. I finally felt like my body was doing what it was supposed to do.”

In the end, Kim decided to wean: “After I started really thinking about it and took the emotional piece out, I knew there was just no way,” she said.

During her recovery, her emotions swung from grief to guilt to resignation, Kim says: “I went through a period of just sadness at that time I was feeding with a bottle. Logically I knew I made the right decision—it was not going to be possible—but emotionally it was another world. I would bounce back and forth, and just when I would get emotional, I would try and tell myself I wasn’t being realistic. You have to convince yourself and get support for that.”

When a mother must wean immediately for medical reasons, support is essential. Mairéad Murphy, IBCLC and La Leche League Leader in Dunboyne, Co. Meath, Ireland, explained: “It’s important that such moms get help on a practical level, because they may need to do some expressing to avoid engorgement and mastitis. But they also need support just to come to terms with the whole thing. It is very much a process of loss and grieving, because this portrait they had of being a mother has changed drastically.”

Kim had planned on a natural labor and birth with midwives, but she ended up with a last-minute Cesarean section. Neither Kim’s birthing experience nor her breastfeeding experience turned out as she wanted.

“I had expectations about how my birth was going to go, and it didn’t go that way,” she said. “And if you go to breastfeeding class, and they tell you all of the benefits and how it is so superior to formula, then you do feel guilty [if you can’t breastfeed]. It’s that mother nurture instinct—you just want to provide.”

When Weaning is the Only Option

It was about the time of her daughter’s first birthday when Wendy Friedlander received the devastating diagnosis that she herself had a rare form of cancer that would require her not only to wean her daughter but to live apart from her for a year while she underwent chemotherapy treatment.

“That was the hardest conversation I ever had in my life,” said Wendy, who lives in New York City, USA. “I wept three boxes of tissues. The doctor literally told me I had to give up a year of my life to save the rest. I had a week before treatment started, before I knew I would have to wean. And it wasn’t just stopping the nursing, it was everything—the babywearing, the breastfeeding, the cosleeping.”

Daytime weaning was easier than expected, as her daughter filled up on hugs and smiles instead of nursing for comfort throughout the day. However, night weaning was more traumatic. In her blog post “Weaning Early,” Wendy wrote: “The night weaning was like ripping off a Band-Aid. Where I was the Band-Aid, and just like that, I was taken away, and it was up to my daughter and her father to get through those first milk-less nights.”

With her large supply of milk, it was imperative for Wendy to continue pumping regularly because a blocked duct could turn into a life-threatening infection. It was a difficult balancing act, removing enough milk to prevent problems while at the same time trying to decrease milk production, all while she was extremely ill from treatments and living apart from her family.

“Everything else seemed so big, weaning was just an aside,” Wendy wrote. “And yet, the pain and heartbreak were tremendous.”

Education and Support are Critical

Apart from genuine contraindications to breastfeeding, there are many medical conditions and circumstances that may affect breastfeeding. With the right diagnosis, information, intervention and support, some breastfeeding may be possible if desired by the mother. Sometimes temporary weaning is needed, or a mother may need to supplement with expressed milk or formula.

Medical professionals may act as barriers to breastfeeding at times: “There are some conditions where breastfeeding is contraindicated, and it’s quite right,” Murphy said. “And there is another group of conditions where mom is told not to breastfeed, and it’s not the truth.”

This is not a condemnation of physicians, most of whom are caring individuals who have the best interests of their patients at heart. However, crushing patient loads, the critical need for good outcomes and simple lack of the most up-to-date information on lactation may lead them to make recommendations that unnecessarily compromise breastfeeding. This underscores a mother’s need for self-education and support.

Mihaela [last name withheld by request] had hepatitis B as a child but had no further problems with the condition for the rest of her teen and adult years. When she was 26 weeks pregnant, a blood test showed what her doctor called “pregnancy hepatitis.” Upon receiving this frightening news, she began having contractions. She spent the next seven weeks in the hospital on bed rest, taking medications for the hepatitis and to prevent further contractions.

“Later on, I learned that even if I had had hepatitis, the chances that the baby would have caught it were minimal,” Mihaela said. She also learned she might not have needed to take the medications she was on.

“I didn’t think to read about it myself. It’s a doctor’s responsibility, and if he doesn’t tell you and can’t self-educate, then you can’t protect yourself,” she added.

Her daughter was born at 34 weeks and was placed in an incubator almost immediately, so Mihaela didn’t have the chance to see her for several hours and didn’t hold her until the next day. Her doctor told Mihaela that she shouldn’t breastfeed because of the medications, and she was given pills to stop lactation.

“I was really sad because I imagined that I would be able to do that, but I didn’t have too much time to think about it [the doctor’s recommendation],” said Mihaela, who had assumed she might be able to begin nursing the baby after a day or two.

She and her daughter spent two weeks in the hospital, in separate rooms, until the baby was gaining weight steadily enough to go home. Looking back, she still feels regret and sadness.

“I feel it would have been much, much easier with breastfeeding,” Mihaela said. “I had moments when I was holding her, and she was close to me…breastfeeding would have complemented that.”

It was especially tough when her daughter would nuzzle her breasts, searching for a way to nurse, Mihaela said: “I would have to take her away from the proximity of the breast. It was really hard.”

Common Complications

If a mother requires medication, she may be told she shouldn’t breastfeed, advice based on resources doctors commonly use, such as the Physician’s Desk Reference or information from the drug manufacturers. According to La Leche League International (LLLI), these resources do not contain complete information about effects on breastfeeding, and very few medications are truly incompatible with breastfeeding. A more useful reference is Dr. Thomas Hale’s Medications and Mother’s Milk or LactMed, the U.S. National Institutes of Health’s Drugs and Lactation Database.

Before Wendy’s biopsy, she asked her anesthesiologist for a list of medications needed for the procedure, “and he didn’t want to give them to me, because he knew I wanted to know for myself when I could nurse my daughter again,” she said. The anesthesiologist told Wendy he would not do the procedure unless she agreed to wait 24 hours to nurse. In the end, Wendy did obtain the list of medicines and learned that she only had to wait eight hours to breastfeed.

There are a number of common conditions that generally should not hinder breastfeeding but often do.

Mastitis is an inflammation in the breast requiring frequent and thorough removal of milk, along with plenty of rest for the mother. “Empty breast, lots of rest,” recommends LLLI. Weaning is not required and may actually worsen the condition. If an antibiotic is needed, there are choices compatible with breastfeeding.

“But it’s still very common that a mother will go to her doctor with symptoms which may or may not be mastitis, and she is often told she needs antibiotics and she must wean in order to take them,” Murphy said. “Sometimes I find moms are told to wean for the duration of antibiotics, but this may be seven to 10 days, and for a very young baby, that may create difficulty getting back to the breast. Or a mother may have trouble keeping her milk supply up. Whereas if she was given the direction of getting into bed, feeding a lot, taking painkillers and so on, it may resolve quickly by itself.”

Many of the common causes of mastitis can be resolved with the help of a lactation consultant, and this is especially important if mastitis occurs more than once.

Jaundice, an excess of bilirubin in the infant’s blood, may cause him to be sleepy and less interested in eating. However, because bilirubin is excreted in stool, it’s critical for babies to continue feeding often to resolve the condition. Mothers may be encouraged to supplement with formula while continuing to breastfeed, which can interfere with milk production and baby’s interest in feeding. Rather than go down the route of giving formula, Murphy says mothers can be shown how to rouse a sleepy newborn, how to get him to take extra feeds and how to supplement if needed.

Once a mother begins supplementing with formula, she might not want to stop, because knowing the exact amount the baby is eating helps moms feel more confident, especially in the face of medical problems. It can be hard for a mother to regain trust in her ability to know that her baby is getting enough milk from breastfeeding.

“Sometimes I think with breastfeeding issues, if you could bottle confidence and give it to mom to drink, then everything would be sorted,” Murphy said. “We are so distanced from the knowledge of normal baby behavior. That lack of recognition causes a lot of problems.”

Deciding to Wean

Sometimes a mother may feel that weaning is the best option for her and her family.

“It all comes down to giving the mom information and letting her make a choice with her specific caregiver,“ Murphy said. “Lots of moms have a different path they are prepared to take with breastfeeding.”

When a mom decides to wean, a good lactation consultant or breastfeeding counselor will respect that and reassure her of the good she has done by breastfeeding up until that point.

“And it truly is good, no matter if she has breastfed for two days,” Murphy said.

Due to the stress and uncertainly caused by breastfeeding difficulties, weaning may bring great relief to an anxious mother. The day I (the author) brought my oldest son home from the hospital was the most stressful day of my life. Breastfeeding was not going well, possibly due to a related medical condition, and I was overwhelmed with worry. After well-intentioned but misguided advice from two counselors didn’t help resolve the issues, and after nine exhausting weeks of nursing, pumping and bottle feeding around the clock, I decided to wean. Though I felt tremendous grief and guilt, I was so relieved be free from the ongoing stress of breastfeeding. It was the right decision at the time—and it also fueled my determination to educate myself and get more support when my second child was born. Mothers who wean may appreciate tips on how to mother the baby in a way as close to breastfeeding as possible.

“Sometimes moms see the end of breastfeeding as the end to all that loveliness, but there are still important ways to enjoy the baby,” Murphy said.

Otherwise known as “bottle nursing,” a term coined by Attachment Parenting International founders Lysa Parker and Barbara Nicholson, authors of Attached at the Heart, mimicking breastfeeding behaviors when bottle-feeding include plenty of eye contact, snuggling at feeding times, skin-to-skin contact and feeding on demand. Mothers may also find bathing together and cosleeping helpful for establishing that initial bond with baby.

Moving On

The process of making peace with weaning is different for every mother, and regret may linger.

“I only listened to one person,” Mihaela said. “I didn’t investigate the problem too much. What I would do is read more, ask more. If I had known more about how the baby would be affected, then probably I would have made other decisions.”

Kim had a strong support network of friends with a variety of breastfeeding experiences, friends who helped her come to terms with her experience.

“You have to say to yourself: This does not make or break your relationship with your child, this is not going to be the one and only bonding thing with your child,” she said.

Now a few years past her successful treatment, Wendy said, “It was a gift in so many ways in the end.”

She says her experience improved her relationships with everyone in her life, and it also left her daughter with a huge network of adults with whom she is very close, though the relatives caring for her daughter during Wendy’s illness didn’t always adhere to the same secure attachment-minded practices that Wendy did.

“In the end, it doesn’t matter because they loved her,” she said. “When it comes to a situation where you are low on reserves and low on support, there is only so much one person can do. Your children are getting served by love. That is the number-one thing that serves them.”

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

For so many women, breastfeeding was the turning point for our journey into Attachment Parenting. And one organization that many of us have to thank for our introduction to both breastfeeding and Attachment Parenting—even in the case of API’s cofounders Lysa Parker and Barbara Nicholson, coauthors of Attached at the Heart—is La Leche League (LLL) International.

Jeanne Stolzer, PhD, Professor of Child and Adolescent Development at the University of Nebraska in Kearney, USA, whose research is known worldwide as an intelligent challenge to the current Western medical model that seeks to pathologize normal human behaviors including breastfeeding, shares her beginnings in LLL.

“Most people think that because of the research I do, I was raised in a granola-eating, breastfeeding, bare-footed family,” Stolzer said. “Nothing could be farther from the truth. The first breastfeeding baby I ever saw was when I was 18 years old, and I was mortified. Five years later, I saw a woman with a PhD breastfeeding a 3-year-old, and my immediate response was, ‘What is wrong with her?’”

Some years later, Stolzer herself was expecting a baby when a friend encouraged her to attend a LLL meeting: “I was very reluctant, but I went,” she said. As fate would have it, “I instantly felt like I was with kindred spirits.”

“For 99.9% of our time on this earth, we have been hunters or gatherers, and we have been practicing esoteric mammalian parenting,” said Stolzer, meaning non-medicalized births, breastfeeding and staying in close proximity to our babies. “Look at what, in just 100 years, we’ve done: We’re supposed to be the top mammal on the planet, but we’ve managed to completely erase the mammalism in our lives.”

Conception, pregnancy, birth and breastfeeding are intricately linked together as one continuous process to give each baby the best start in life, Stolzer explains: “Most people see these as separate. They’re not. If you mess with one, you risk throwing off the whole connection.”

While there are a very small number of females in every mammal species unable to get pregnant, the United States has the highest infertility rate in the world among humans. But is there any wonder when we stop to look at what Western cultures are doing to the birthing and breastfeeding functions of this process? Stolzer finds it comical that most mothers won’t touch a cigarette or a caffeinated drink while they’re pregnant—which is commendable—but then have no problem in going to a hospital and having powerful narcotics mainlined into their arm during labor and birth. In the United States, 38% of women are getting Cesarean sections when, naturally, only 1 to 3% of births might actually require medical intervention.

Then mothers and their newborn babies are, more often than not, separated immediately after birth. If a mother is able to give birth vaginally, she is flooded with hormones, but by separating the mother from her baby, that hormone flow is interrupted. As if the breastfeeding relationship isn’t challenged enough by separation, then it has to overcome the ordeal of a hormonally-deficient mother and a drug-affected baby: “It takes 138 muscles alone in the jaw to nurse, and if you’re drugged, they won’t work,” Stolzer said.

The truth is, most Western physicians are not educated in breastfeeding. To be so, they must go on to continuing education because medical schools don’t teach lactation.

“I think women do the very, very best they can with the information they have at the time,” Stolzer said. “Breastfeeding decreases all forms of hospitalization, death and prescription drug use. That’s amazing, but how many women who are formula-feeding know this?”

Introduction of Formula Feeding

Formula was developed with the mechanization of the dairy industry and is derived from whey, a byproduct of processing cow milk.

In 1910, only 2 to 13% of mothers formula-fed. After World War I, that statistic jumped to 65 to 70%, and the impression was that only the poor and the immigrants had to “resort” to breastfeeding. Formula feeding had become a status symbol of wealth, and physicians were supporting that formula feeding was superior to breastfeeding. The lesson learned here, says Stolzer, is to question your societal trends: “Formulas are manufactured by pharmaceutical companies. Look at who’s funding every study: If it’s a pharmaceutical company, don’t even read it—it’s propaganda.”

In reality, human milk is far better than any substitute milk. Human milk changes with each child, depending on the needs of that particular child during a particular time of the day, during a particular age of that child. Human milk—and breastfeeding, for that matter—quite simply, can’t be duplicated.

“Pumped milk is infinitely better than formula,” Stolzer said. “However, it would be a scientific fallacy to say that pumped milk is the same as milk from the human breast,” because of how breast milk changes throughout the day, not to mention that feeding by a bottle misses the intricacy of the relationship aspects of breastfeeding.”

Human milk is a dose-responsive, specific variable, meaning the response is specific to the dose: the more that a baby is breastfed and the longer a baby is breastfed, the more benefits that breast milk affords to the child and the mother. Research that began in the 1920s clearly shows that breastfeeding reduces the risk of myriad physical and mental health conditions for both baby and mother, through protective antibodies and enzymes, and through the oxytocin and prolactin “love” hormones secreted with each breastfeeding interaction.

“Choosing not to breastfeed brings a halt to oxytocin and prolactin. This brings on the grief response in mammals,” Stolzer said. “That’s why we have [high] postpartum depression rates in this country. Because the body believes that we’re grieving.”

In addition, it’s important to note the differences between cows and humans on an animal level. While both are mammals, humans and cows are not nearly the same. There are two types of mammals on the earth, in terms of how they care for their young:

Caching—i.e., cows. These mammals give birth to young who are, soon after birth, able to walk, regulate their own temperature and be left alone for periods of time while the mother forages for food. Feedings are meant to be spaced to allow this, and therefore, the milk produced is high-protein and high-fat.

Carrying—i.e., humans. These mammals give birth to young who are unable to walk, regulate their own temperature or stay quiet for long periods of time alone, and therefore must be kept in close physical proximity to the mother. Feedings are meant to be continuous and on demand, and the milk produced is low-protein and low-fat.

Quite simply, cow or soy milk formula cannot be as good as human milk for human babies: “It makes sense: We have such a different brain than a cow, and a soybean doesn’t even have a brain,” Stolzer laughed.

All kidding aside, human mothers treat their babies like those of caching mammals. This is evident not only in formula sales—a $1 trillion industry—but also in the boom in sales of helmets meant to reshape the heads of babies whose heads are flattened on one side because the baby spends more time lying down than being held.

Another important argument against formula feeding is the increasing rate of food allergies in Western cultures, Stolzer said: “The number-one allergen in human populations is dairy products. The number-one ingredient in formula is dairy. Of course we’re doing this.”

Extended Breastfeeding is Best

According to World Health Organization recommendations, babies must be breastfed for at least two years to obtain optimal benefits. Developmentally, human children are designed to breastfeed well over two years of age. For example, permanent molar eruption doesn’t occur until the child is 5 to 7 years old. In another example, Stolzer shares: A child’s sucking needs last for three to seven years—evidenced by prolonged thumb-sucking, pacifier use and hair-sucking in older children.

The average breastfeeding weaning age worldwide is three to four years. In the United States, weaning typically happens at only six weeks, the time when women return to work outside the home. The breastfeeding research available clearly shows that if all women in the United States breastfed exclusively for just six months, the nation would save $3.6 billion a year, mostly in health care costs and time spent paying parents for sick time to stay home to care for their children. If they breastfed exclusively for one year, the savings would climb to $7 billion a year.

“Five thousand to 6,000 years ago, mothers were breastfeeding their children until about 7 years old. They were ensuring the survival of the human species,” Stolzer said. “Not only is the human brain not done growing until the child is 5 to 7 years old, but the human immune system is not fully developed for five to seven years.”

Breast milk naturally has more antibodies available for the older child, because babies are designed to always be with their mothers. That’s why breastfed babies in child care centers still get sick: The antibodies in their mother’s breast milk are designed to ward off family germs, not germs from the whole community. The antibody load naturally increases as the child becomes more mobile, Stolzer explains.

It’s time that Western cultures quit playing it safe when it comes to educating women about breastfeeding, Stolzer says. The benefits of breastfeeding are consistently dependent not only on the frequency and intensity of each nursing session but also on the duration.

Worth the Work

One of the concerns of Attachment Parenting is the physical work involved in the early years, especially the first few months, when the baby’s natural sleeping and feeding schedule is so contrary to the parents’ pre-baby schedules and to what the parents want to return to because of what Western culture promotes as “normal.” But Stolzer encourages parents to stick with it.

“I know it feels really intense right now—and it is really intense right now—but in the time between birth and death, this really intense time is very small,” she said. “Attachment Parenting does not ensure that babies won’t cry or make choices that will hurt you or make you so mad you could flip,” she added. “But if you lay that foundation with Attachment Parenting, that path [of loving interaction] will always be there for them to find again.”

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

Public breastfeeding can infuriate us, scare us, make us feel ashamed or empower us. For one Chicago mom, it empowered her to take action and create an organization that would focus on advocating for breastfeeding at a larger level in her city (located in Illinois, USA). She wanted not only to help raise awareness of the benefits of breastfeeding but to ensure that mothers feel comfortable feeding wherever and whenever their babies are hungry.

Breastfeed, Chicago! is making changes for Chicago, one mom at a time, through a very talented board of directors that help to put together the group’s advocacy campaigns. I sat down with Katrina Pavlik, the founder of Breastfeed, Chicago!, to find out more about the organization and advice she has for others who want to advocate for breastfeeding in public. We met on a brisk day on the southwest side of Chicago and sat down over some hot coffee to chat about breastfeeding.

PATRICIA: Tell us how Breastfeed, Chicago! came to be.

KATRINA: In 2011, I created a closed Facebook group to invite people to start a conversation about breastfeeding in Chicago. Within six hours, it had grown to 400 people. (As of this writing, the group boasts a membership of 2,287 members, and more people are added daily.)

I saw a need for a community that could discuss how to make Chicago more breastfeeding friendly. From the Facebook group, we expanded and added the Breastfeed, Chicago! blog and resource list.

I wanted to see moms having more of a voice in writing policies.

PATRICIA: Chicago and the surrounding suburbs boast a high number of La Leche League (LLL) and Breastfeeding USA groups. What is different about Breastfeed, Chicago!?

KATRINA: LLL and Breastfeeding USA are so important. They provide breastfeeding support, which is critical for new moms just getting started.

Our organization is about advocacy and policy. We are working to change the view of breastfeeding. We are working on raising awareness, educating the public and advocating for policy changes.

PATRICIA: Tell us about the advocacy efforts Breastfeed, Chicago! is working on.

KATRINA: One of the big projects we are working on is a letter-writing campaign. One of our board members drafted a letter that we send out to businesses. It basically goes over Illinois breastfeeding laws and gives some information about working with breastfeeding moms. We ask that the information be posted in the employees’ space, such as a break room, so all of the employees from the top down are receiving this information. The letter is also available on the Breastfeed, Chicago! resource list so that parents can print it out and send it to any business that they feel would benefit from this information.

We also are working on a sticker campaign. We have printed up Breastfeed, Chicago! window decals that businesses can place on their doors or windows that indicate that this is a breastfeeding-friendly business.

We really want this to be mom-driven, so we have these travelling baby cafes in the summer. We meet in different areas around the city, and moms can get together, have a cup of coffee and chat. It’s an opportunity for us to brainstorm ideas that will help make Chicago more breastfeeding friendly. We take the stickers with us and moms can take a stack and hand them out at their favorite businesses, restaurants, et cetera.

The blog also has an advocacy tool kit that can be downloaded. It includes information on your rights as a breastfeeding mom in public and at work. It has tips for advocating for yourself and your child, questions to ask your pediatrician, tips to make breastfeeding in public more comfortable. It also includes a letter that you can send to your birthing hospital to express your gratitude or disappointment with their approach to breastfeeding. And it includes the window sticker and a letter that accompanies the window stickers, explaining the sticker campaign.

PATRICIA: I noticed you didn’t mention nurse-ins.

KATRINA: Breastfeed, Chicago! has never implemented a nurse-in. We want to circumvent the nurse-in. We want to normalize breastfeeding and implement interventions that will make this normal. Nurse-ins are a tertiary intervention. We are looking at what can we do before that.

When thinking about a nurse-in, there are a few factors we want to think about. One thing I always try to think about is the mom-to-be, the woman who hasn’t had her first baby yet. What message does a nurse-in send to her? [That] this is so abnormal people have to stage protests in order to do it. We want her to get the message: “This is what all my friends are doing. I see it. It’s normal.”

Nurse-ins also serve to embarrass the individuals involved. Similar to the way we raise our children, we don’t want to punish and embarrass people into change. We want to teach them and educate them into changing their behavior.

PATRICIA: What advice would you have for parents in other cities who would like to take on a venture like Breastfeed, Chicago!?

KATRINA: Use social media. Moms are online all day everyday. Moms will come together and build community. Once that community it built, moms will start to share their needs. Make sure you are listening, and when a mom brings up a need, step back and contemplate and ask yourself, how do we make this better for all moms?

Make sure you reach out to your local breastfeeding professionals. Make them feel important, and ask them to be a part of what you are doing.

And be aware that things move slowly.

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

The recent controversies generated by depictions of Attachment Parenting in the Western media and elsewhere have revealed a fairly astounding degree of misinformation about infant and child development. Most especially, the media’s fetishist focus on “extreme breastfeeding” has revealed the tremendously wide chasm that exists between official medical recommendations about breastfeeding and the actual reality and perception of the practice on the ground.

Discussions generated by overly sexualized and highly sensationalized depictions of breastfeeding have often helped only to bolster a set of beliefs about the practice that are as dangerous as they are inaccurate. Though breastfeeding is touted by almost every recognized medical body as being one of the best things a mother can do to ensure the health and well-being of her child, the fact remains that very few infants are exclusively breastfed during their first six months of life and even fewer still are breastfed beyond their first year as official medical guidelines recommend.

Breastfeeding older babies, sometimes referred to by advocates as full-term breastfeeding, means different things to different people. Though some feel that nursing an infant past one year should be considered full term, others define it as breastfeeding a child past the age of two. Perhaps more important than any specific age reference is instead a commitment to continue breastfeeding until a child initiates the weaning process.

While beliefs and approaches to breastfeeding have certainly varied widely through time and place, the current level of societal discomfort breastfeeding engenders is without doubt an anomaly. What has since our earliest days been central to our very survival as a species has, more recently, been made to seem—by some of the more vocal critics at least—as an unnatural, immoral and even perverse practice when engaged in beyond the first year of an infant’s life. Thus, mothers who breastfeed their toddlers and very young children have been called everything from odd and eccentric to sexually perverse and even abusive.

What may therefore come as a shock to many in the West today is that from an historic and cross-cultural perspective, breastfeeding older babies and very young children is the norm. As Cornell University (USA) anthropologist Meredith Small, PhD, surmises in her groundbreaking work Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent, the “hominid blueprint of the way babies were fed for 99% of human history indicates breast milk as the primary or sole food until two years of age or so, and nursing commonly continuing for several more years.”

Breastfeeding children until the age of three or four years has been the norm throughout much of human history and remains so in various parts of the world today. Even as late as 1800, an infant born in the United States could expect to be nursed for somewhere between two to four years.

What happened over the last 200 years to have so dramatically altered breastfeeding patterns is too complicated a history to review here. It is needless to say, however, that despite no shortage of scientific and medical evidence to support much longer-term breastfeeding, this has not been enough to sway popular practice or belief in any large measure. In the United States, Canada and elsewhere, breastfeeding beyond a year—or two for the more progressive types—raises eyebrows and even ire amongst some otherwise seemingly rational people. As discussed further below, though breastfeeding rates are on the rise, the increases are small, and breastfeeding older babies is still a far cry from the cultural norm in the West.

The Science

Not only does the historical and anthropological evidence suggest that weaning before age two is unusual, but from a purely biological perspective, nursing a child through the toddler years is not in the least bit abnormal. In fact, the typical age for child-led weaning from a physiological standpoint has been estimated to fall within the broad range of two and a half to seven years of age.

As Katherine A. Dettwyler, PhD, an anthropology professor at the University of Delaware (USA), has demonstrated, this large spectrum is based upon an analysis of various biological and physiological factors derived from comparisons to other mammals of similar size. When looking at the relationship between gestation times and weaning for instance, human babies are geared to wean somewhere around four and a half years of age. Other relevant mammalian comparisons also support a much longer breastfeeding duration, including:

the eruption of the first permanent molars—5.5 to 6 years

adult body weight—4 to 7 years

adult body size—2.8 to 3.7 years.

Even the most conservative estimate, derived from an analysis of human birth weights, would suggest natural weaning occurs between 25 and 32 months of age.

The health benefits of breastfeeding are, of course, much more widely acknowledged. Not only do breastfed babies suffer fewer childhood illnesses and recover faster when ill, but the benefits continue to accrue throughout their adult lives. In every scientific study comparing breastfed babies and formula-fed babies, the breastfed babies have been shown to have a lower risk of disease and to score higher on cognitive functioning.

Breastfed babies have a much lower risk of dying from Sudden Infant Death Syndrome (SIDS) than do their non-breastfed counterparts; the formula-fed infants being, in fact, twice as likely to die from SIDS. According to “The Surgeon General’s Call to Action to Support Breastfeeding 2011,” formula-fed infants are also at a higher risk of common childhood infections, including gastrointestinal problems and ear infections, with the risk of the latter being a whopping 100% higher than in their breastfed counterparts.

The same report goes on to say that babies who are exclusively breastfed during the first four months of life have a 250% lower risk of being hospitalized for lower respiratory tract disease and a lower risk of respiratory infections. Breastfed babies also have a lower risk of developing leukemia. Formula feeding, as opposed to breastfeeding, is furthermore associated with an increased risk of some of the most serious chronic diseases of our time, including type 2 diabetes, childhood obesity and asthma.

While the early months are by far the most important with regard to the benefits of breastfeeding, research has shown that the health benefits of breast milk are cumulative. Thus, babies breastfed for 18 to 24 months do better than those breastfed for only the first six months, though as mentioned, the early months are certainly the most crucial.

While as of yet no large scale studies have been published on the specific health benefits of breastfeeding past two years of age, as Dettwyler and others have convincingly argued, there is little reason to believe the rewards cease immediately upon a child’s second birthday. Research has conclusively shown that the specific qualities of breast milk change over time in order to meet the nutritional needs of children as they grow. As such, there is evidence to suggest that breastfeeding beyond two years continues to offer important health benefits. As one of the foremost experts on the subject, Jack Newman, MD, at the International Breastfeeding Centre in Toronto, Ontario, Canada, argues, “Breastmilk still contains immunologic factors that help protect the child even if he is two or older.”

Mothers benefit enormously from the breastfeeding relationship too. For instance, it has been shown that the longer a woman spends breastfeeding, the lower her risk of ever developing breast cancer. Likewise, women who have never breastfed have a 27% higher risk of developing ovarian cancer compared to women who have breastfed for some period of time. Studies have also shown that breastfeeding for longer can maximize these protective effects. Overall, the report by the U.S. Surgeon General cited above concludes that “exclusive breastfeeding and longer durations of breastfeeding are associated with better maternal health outcomes.”

Breastfeeding Rates

The “Breastfeeding Report Card—United States, 2012,” published by the U.S. Centers for Disease Control and Prevention (CDC), found that while national breastfeeding rates are on the rise, there is still a very long way to go in terms of meeting guidelines set out by almost every recognized medical body or health association across the globe.

While current recommendations as set by the World Health Organization (WHO) and echoed by many other organizations suggest that breastfeeding be continued for two years or longer if mutually desired by mother and child, the majority of infants in the United States are weaned by six months of age. Thus, although 76.9% of women in the United States initiate breastfeeding at birth, just under half of these women are nursing at six months and only a quarter of them are still breastfeeding at one-year postpartum.

WHO guidelines likewise stress the importance of exclusive breastfeeding for the first six months of an infant’s life. Exclusive breastfeeding means giving the baby nothing but breast milk during this time. Again, despite the slew of data on the vital importance of following these recommendations, according to the U.S. National Immunization Survey (latest data for 2008), only 14.6% of babies are exclusively breastfed at six months.

As surmised by the Surgeon General’s 2011 Call to Action, although “many mothers in the United States want to breastfeed, and most try … within only three months after giving birth, more than two-thirds of breastfeeding mothers have already begun using formula.” This statistic is hardly surprising when one considers that in a study co-funded by the CDC and the U.S. Food and Drug Administration, it was found that almost half of breastfed newborns were being supplemented with formula while still in the hospital.

From a purely economic vantage point, these findings are extremely important. In fact, a study published in the April 2010 issue of the journal Pediatrics examined the costs (adjusted to 2007 dollars) associated with various illnesses including SIDS, hospitalization for lower respiratory tract infection in infancy, atopic dermatitis, childhood leukemia, childhood obesity, childhood asthma and type 1 diabetes, and found that if “90% of U.S. families followed guidelines to breastfeed exclusively for six months,” the direct and indirect savings of medical expenses would equal some $13 billion annually.

Challenges and Barriers

As evidenced above, it is quite clear that the widely available wealth of information concerning the array of physical, physiological, social, emotional, cognitive and even fiscal benefits breastfeeding provides has not been enough to alter public practice on a large scale. Thus, though the medical evidence is unambiguous and educational campaigns to shore up support for breastfeeding are now common, very few families seem to be able to actually put these recommendations into practice.

Why might this be? As revealed by a 2005 U.S. National Survey conducted by the nonprofit Families at Work Institute, more than 60% of mothers of infants and young children work outside the home. U.S. law requires only 12 weeks unpaid maternity leave be afforded to new mothers and this only for companies with 50 employees or more. A report by the National Partnership for Women and Families found that almost two-thirds of women are left without access to employer-provided short-term disability benefits, while nine out of 10 members of the workforce are unable to draw upon employer-provided paid leave to care for a new infant.

Another study published in the February 2012 issue of the journal American Sociological Review revealed that those women who breastfeed their infants beyond six months see a steeper decline in their earnings than those working women who use formula or wean their babies earlier. As Phyllis Rippeyoung, one of the study’s researchers suggested, the results of the study demonstrate that “at least as work is organized right now in the U.S., there does seem to be an incompatibility between breastfeeding for a long duration and working for many women.”

This is, of course, not to say that women who work outside the home do not, or cannot, practice longer-term breastfeeding. However, as only about a third of even the largest companies in the United States provide women with a secure area to express breast milk, doing so can often require an extremely high level of ingenuity and commitment.

Studies like those above highlight a reality too often ignored in breastfeeding campaigns: breastfeeding is both time and labor intensive. Without adequate economic, political, practical and community support for breastfeeding—spanning from the institution of much better maternity leave policies to more family-friendly workplace arrangements—many mothers will continue to face a variety of obstacles that make conforming to ideal breastfeeding practices extremely challenging at best.

Though these barriers certainly require redress if exclusive and full-term breastfeeding is to become more common, providing better maternity leave by itself may not necessarily translate into major improvements. If one looks at the Canadian situation in which maternity leave policies are a good deal better, the numbers are almost as dismal. At three months postpartum, less than half of Canadian mothers are exclusively breastfeeding, and by six months, only 14% are offering nothing but breast milk. At 12 months, about a quarter of Canadian infants are receiving some breast milk, a number only marginally better than the U.S. figures.

It seems, therefore, that something else must also be afoot. As Small and others have pointed out, underpinning these very real structural barriers to breastfeeding is a belief system that is fundamentally at odds with the biological imperatives of infant and child development. In a culture in which independence and autonomy are so highly prized that infants as young as a few months are expected to self-soothe, parents are all too frequently made to feel conflicted about responding to the cues of their infants.

This rather peculiar state of affairs has unfortunately also led to the abandonment of a host of practices that have historically been integral to exclusive and full-term breastfeeding. Regrettably, many of the practices that have traditionally helped to ensure the success of the breastfeeding relationship have become marginalized and, in some cases, even vilified in the West.

The practice of cosleeping—which had been the norm throughout most of human history and continues to be in much of the world today—though never fully eradicated, was until very recently effectively forced underground by a campaign of misinformation. Practices such as cosleeping, babywearing and comfort nursing (soothing baby with the breast instead of a breast substitute such as a pacifier or bottle), to name just a few, support breastfeeding by allowing for unrestricted access to the breast. Unrestricted access encourages a mother’s milk production and ensures a healthy feedback loop. Unrestricted access is, however, precisely that which is so often lacking today.

In sum, the abandonment of practices that support breastfeeding necessarily hampers the effect of even the most progressive policy initiatives on the ground. Simply declaring the importance and sanctity of the breastfeeding relationship, however vociferously, will have very little effect in a society that in actual fact values, and even incentivizes, mother-infant separation from an early age. Unfortunately, we live in a time in which mainstream culture sanctions by both word and deed an approach to parenting that is totally out of sync with the needs of our children. As such, the hyperbolic reactions generated by images of older babies breastfeeding and the dire state of actual breastfeeding practices are together merely twin symbols of the very widespread misunderstanding of the attachment relationship and of infant development more generally.

The fact remains that while educational initiatives and institutional changes may help to increase breastfeeding initiation among new mothers, without a fairly dramatic re-evaluation of our current beliefs, practices, values and priorities surrounding infant and child care at large, exclusive and full-term breastfeeding will continue to be a practice of only a minority.

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

My name is Melissa, and I am a mama to four kiddos. I’ve been an Attachment Parenting mama since before I knew it was a phrase. For me, having the “perfect birth” with my first baby was The Most Important Thing Ever. I really can’t stress enough how tied up I was in having a perfect birth: dim lights, soft music, soft voices, at home, with just a doula and my then-husband. I would catch the baby in my arms, and we would cry and laugh, and I would heal so quickly, and life would be perfect.

Editor’s Note: As one of the Eight Principles of Parenting, Attachment Parenting International encourages parents to prepare for pregnancy, birth and parenting, which includes informing themselves about healthy birth and birth options. API birth stories are published for the purpose of giving parents a voice in telling their birth stories, and these stories include decisions and understandings that represent various levels of understanding about optimal birth choices. The author’s description of her experiences should not be considered medical advice or representative of API Principles. Representative of the API Principles in this birth story are the pursuit of education, knowledge, and empowerment as a parent to guide the choices that suit the well-being of one’s own family.

Then reality struck. At 20 weeks pregnant, my baby was diagnosed with intrauterine growth restriction, and I was told I had a placenta previa. This meant immediate bed rest with the strong possibility of a Cesarean section later. I was crushed.

At 35 weeks, though, my spirits were renewed when the doctor found that my placenta had moved, so a vaginal birth was now a possibility. However, since my little one still wasn’t growing very well, I would remain on bed rest and would not be allowed to have a homebirth. My now ex-husband was in the Marines, and “allowed” is the exact word for how pregnancies were handled by our military hospital at that time.

No one asked about my birth preferences, but I had a printed birth plan. It is my understanding that my husband was asked about circumcision, but neither of us was asked about formula, sugar water or pacifiers. My husband was aware of my feelings about circumcision, that I preferred the baby be left intact. I explicitly stated in my birth plan that I wanted to breastfeed within an hour of giving birth and that the baby was not to receive bottles or pacifiers.

Labor came on quickly one night when I was nearly 40 weeks along. I had no pain or even real discomfort, and then suddenly, BAM, full-blown labor. I managed to call my husband, who came home from his second job, saw how very in labor I was, freaked out and called the ambulance. By the time I got to the hospital 20 minutes later, I was 7 cm dilated and fully effaced.

The hospital handled my birth in the same controlling way they handled my pregnancy:

“No! Of course you’re not allowed to get out of bed!”

“What? Why would you want to eat or drink right now? You’re in labor, get back in bed!”

“Yes, you HAVE to have an IV.”

“This is your first baby; you have no idea what you’re doing.”

That last line is what I heard when I said that I thought labor was going a lot faster than I thought it would, and I didn’t think it would be too much longer before baby got here.

Hearing those words was the final straw. I was 19. I was in horrific pain. I was tethered in bed with the IV, monitor and cables so I couldn’t get up or move. I was being talked down to. I started to cry. Then I started to yell. That’s when a nurse walked in and said, “The doctor says you can have this for the pain.” With that, she stabbed me with a needle and emptied a syringe of what I later discovered to be Demerol into my arm.

I remember I was on the phone with my mom, trying to tell her what was happening, but as I was speaking to her, the room became dark, and I suddenly couldn’t hear anything. I was blind, deaf, mute and in horrible, horrible pain. Pain was all I could feel. I passed out.

Then three things happened simultaneously: I awoke; my water broke, gushing green, smelly, meconium-filled fluid everywhere; and I screamed involuntarily.

Nurses came running, the doctor came in and everyone started yelling at me, “Stop pushing! Stop pushing!”

I gritted my teeth and yelled back, “I’m not pushing!” The baby was coming. I couldn’t stop it. I wasn’t pushing.

At that point, I reached out for my husband, who was standing off to the side in shock. I put my hand on his arm. A nurse slapped my hand away from him. She said, “He’s your husband, don’t do that to him.” My husband just stared, his jaw agape.

Then, with one tiny push (the only one I was “allowed”), out came my beautiful baby boy. And I passed out.

When I awoke four hours later, my baby had been through the hospital’s baby assembly line: immunization, circumcision, bottle of formula. (Despite my feelings, my husband made the decision to have the baby circumcised.)

I did eventually establish breastfeeding, but due to the lack of support and lactation services in the small town where we moved just after the birth, breastfeeding was very difficult. We dealt with a month of thrush, hyperactive letdown and oversupply issues. Eventually, Riley went on a nursing strike, and I ended up switching to formula.

I suffered severe postpartum depression lasting over eight months following Riley’s birth. I was in the last days of my marriage, only 19 years old and very much alone. I received no support and no help. I didn’t even know where to go for help.

I am still dealing with the emotional trauma of Riley’s birth. The hospital left me feeling powerless and small. Telling my story helps me feel like I’m doing something about it. I’ve had three more children since Riley, and each birth has been immeasurably better than Riley’s, which has definitely helped a lot.

My second birth was with Mason, a late baby born at just over 42 weeks. It required two procedures and three days to get labor started. I had a pretty aggressive doctor, and I was too overwhelmed to speak up and ask for the C-section I felt I needed. Mason nearly died at birth from complications of shoulder dystocia. He was in the NICU for a few hours, but luckily he recovered quickly and was back with me by the next morning.

I don’t compare Mason’s birth to others, because of the complications. The doctor had no way of knowing that there would be an issue of dystocia. That whole situation came down to what was necessary, and not what anyone “wanted.” I don’t feel bad about his birth or particularly good about it–I’m just thankful he survived. As far as circumcision goes, Mason’s dad and I discussed it at length, and I agreed to let him make the decision. He chose to circumcise. I am at peace with that decision because I know that someone who loves my son very much made that choice with love. While I don’t think it was the best choice, it was his dad’s choice, not the hospital’s.

My fourth birth was a scheduled early induction to avoid complications, because the doctor and I both suspected that Harry was going to be a big baby. Given the situation with Mason’s birth, we felt good about proceeding with an early induction. Labor lasted just over two hours. I asked for an epidural, but it failed, so I felt every second of those two hours. Overall, I feel good about this birth, too. And I’m happy to say that Harry is an intact [uncircumcised] baby. He just turned two and is still nursing, thanks to all of the wonderful support I received from La Leche League and the local lactation consultants.

However, I think the birth I felt best about was with my daughter, my third child. On my due date, my water broke on its own at around 10 a.m., before contractions started. I took a shower, got dressed, called the sitter, cleaned the house, and just generally took my time getting everything ready for the baby. At about 3 p.m. my husband and I headed to the hospital. I was started on some Pitocin, and things moved fairly quickly after that. I labored while moving around, walking, eating freely, drinking water and juice whenever I felt like it, with my husband holding my hand and rubbing my back. We watched movies and played cards. Labor was intense but manageable, and the nurses were happy to leave me to it. I had telemetry monitoring, so I could go wherever and do whatever I wanted.

By about 9 p.m. the pain was bad enough that I couldn’t walk or talk or move, so the nurse offered to check me. I was at a very disappointing 3 cm, so I asked for an epidural. The epidural must have made my body relax because my daughter was born less than an hour later after only two pushes.

The doctor laid her on my tummy, and they left the cord alone until it stopped pulsing. The nurses asked if they could please take her to clean her up. They had her back to me, weighed, measured, wiped down and swaddled within 10 minutes. The staff cleared the room fairly quickly, and the lactation consultant stopped by to offer support. I was given a breastfeeding kit (not formula), as well as information on renting a pump and getting an SNS (supplemental nursing system) “just in case.” After that, I was left alone with my daughter and my husband for the rest of the night.

No one questioned my authority in making the decisions regarding my care or the care of my daughter. The two interventions I had were both necessary, and I have no regrets about them. I had good friends who offered advice and assistance in the months leading up to Lana’s birth, and I had a husband who wasn’t afraid to stand up for me.

Having what I considered to be a nearly perfect birth experience gave me hope. For the first time, I stopped blaming myself for the way things went with Riley’s birth. I had always felt like somehow I was the problem in that. But I realized it was just those particular nurses and doctors.

I guess if I had to sum it up in one sentence, I’d have to say that the biggest difference was that with Riley’s birth I was treated poorly and I was the least important person in the room, but with Lana’s birth I was part of the team and the person with the most input.

By Linda Folden Palmer, DC, member of API’s Editorial Review Board and author of The Baby Bond (www.babyreference.com).

Human babies are born helpless, needing to be entirely cared for and protected. Luckily, they are born with all the necessary tools and “instructions” to attain such care for themselves, and to become a loved and loving part of their family and society. The ingrained neural and hormonal interactions provided for parent and child to assist them in this process are among the most powerful in nature. The hormonal cues are clear and compelling, and our instincts can provide us with all the appropriate responses. Without taking great efforts to avoid and ignore such urges, parents will naturally follow the advice of their neurons and hormones, nurturing their babies and maintaining physical closeness with them.

Once born, baby’s hormonal control systems and brain synapses begin to permanently organize according to the human interactions she experiences. Unneeded brain receptors and neural pathways are disposed of, while those appropriate to the given environment are enhanced.

Oxytocin and Bonding

Oxytocin is a chemical messenger released in the brain chiefly in response to social contact, but its release is especially pronounced with skin-to-skin contact. In addition to providing health benefits, this hormone-like substance promotes bonding patterns and creates desire for further contact with the individuals inciting its release.

When the process is uninterrupted, oxytocin is one of nature’s chief tools for creating a mother. Roused by the high levels of estrogen (“female hormone”) during pregnancy, the number of oxytocin receptors in the expecting mother’s brain multiplies dramatically near the end of her pregnancy. This makes the new mother highly responsive to the presence of oxytocin. These receptors increase in the part of her brain that promotes maternal behaviors.

Oxytocin’s first important surge is during labor. If a cesarean birth is necessary, allowing labor to occur first provides some of this bonding hormone surge (and helps ensure a final burst of antibodies for the baby through the placenta). Passage through the birth canal further heightens oxytocin levels in both mother and baby.

High oxytocin causes a mother to become familiar with the unique odor of her newborn infant, and once attracted to it, to prefer her own baby’s odor above all others. Baby is similarly imprinted on mother, deriving feelings of calmness and pain reduction along with mom. When the infant is born, he is already imprinted on the odor of his amniotic fluid. This odor imprint helps him find mother’s nipple, which has a similar but slightly different odor. In the days following birth, the infant can be comforted by the odor of this fluid.

Gradually over the next days, baby starts to prefer the odor of his mother’s breast, but continued imprinting upon his mother is not food-related. In fact, formula-fed infants are more attracted (in laboratory tests) to their mother’s breast odor than to that of their formula, even two weeks after birth.

By influencing maternal behavior and stimulating milk “let down” (allowing milk to flow) during nursing, oxytocin helps make the first attempts at breastfeeding feel natural. Attempts at nursing during the initial hour after birth cause oxytocin to surge to exceptional levels in both mother and baby. Mothers who postpone nursing lose part of the ultimate hormone high provided for immediately after birth. Powerful initial imprinting for mother and baby is intended to occur chiefly so that mother and baby will be able to find and recognize each other in the hours and days after birth.

Yet a lifetime opportunity for bonding and love is not lost if this initial window is missed. Beyond birth, mother continues to produce elevated levels of oxytocin as a consequence of nursing and holding her infant, and the levels are based on the amount of such contact. This hormonal condition provides a sense of calm and well-being. Oxytocin levels are higher in mothers who exclusively breastfeed than in those who use supplementary bottles. Under the early influence of oxytocin, nerve junctions in certain areas of mother’s brain actually undergo reorganization, thereby making her maternal behaviors “hard-wired.”

As long as contact with the infant remains, oxytocin causes mother to be more caring, to be more eager to please others, to become more sensitive to others’ feelings, and to recognize nonverbal cues more readily. Continued nursing also enhances this effect. With high oxytocin, mother’s priorities become altered and her brain no longer signals her to groom and adorn herself in order to obtain a mate, and thus a pregnancy. Now that the child has already been created, mom’s grooming habits are directed toward baby. High oxytocin in the female has also been shown to promote preference for whatever male is present during its surges (one good reason for dad to hang around during and after the birth). Prolonged high oxytocin in mother, father, or baby also promotes lower blood pressure and reduced heart rate as well as certain kinds of artery repair, actually reducing lifelong risk of heart disease.

Although baby makes her own oxytocin in response to nursing, mother also transfers it to the infant in her milk. This provision serves to promote continuous relaxation and closeness for both mother and baby. A more variable release of oxytocin is seen in bottle-fed infants but is definitely higher in an infant who is “bottle-nursed” in the parents’ arms rather than with a propped bottle.

Persistent, regular body contact and other nurturing acts by parents produce a constant, elevated level of oxytocin in the infant, which in turn provides a valuable reduction in the infant’s stress hormone responses. Multiple psychology studies have demonstrated that, depending on the practices of the parents, the resulting high or low level of oxytocin will control the permanent organization of the stress-handling portion of the baby’s brain—promoting lasting “securely attached” or “insecure” characteristics in the adolescent and adult. Such insecure characteristics include anti-social behavior, aggression, difficulty forming lasting bonds with a mate, mental illness and poor handling of stress.

When an infant does not receive regular oxytocin-producing responsive care, the resultant stress responses cause elevated levels of the stress hormone cortisol. Chronic cortisol elevations in infants and the hormonal and functional adjustments that go along with it are shown in biochemical studies to be associated with permanent brain changes that lead to elevated responses to stress throughout life, such as higher blood pressure and heart rate. Mothers can also benefit from the stress-reducing effects of oxytocin: Women who breastfeed produce significantly less stress hormone than those who bottle-feed.

Nor are fathers left out of the oxytocin equation. It has been shown that a live-in father’s oxytocin levels rise toward the end of his mate’s pregnancy. When the father spends significant amounts of time in contact with his infant, oxytocin encourages him to become more involved in the ongoing care in a self-perpetuating cycle. Oxytocin in the father also increases his interest in physical (not necessarily sexual) contact with the mother. Nature now provides a way for father to become more interested in being a devoted and satisfied part of the family picture through his involvement with the baby.

With all of its powers, oxytocin is but one of a list of many chemicals that nature uses to ensure that baby finds the love and care he needs.

Vasopressin and Protection

Although present and active during bonding in the mother and infant, vasopressin plays a much bigger role in the father. This hormone promotes brain reorganization toward paternal behaviors when the male is cohabiting with the pregnant mother. The father becomes more dedicated to his mate and expresses behaviors of protection.

Released in response to nearness and touch, vasopressin promotes bonding between the father and the mother, helps the father recognize and bond to his baby, and makes him want to be part of the family, rather than alone. It has gained a reputation as the “monogamy hormone.” Dr. Theresa Crenshaw, author of The Alchemy of Love and Lust, says, “Testosterone wants to prowl; vasopressin wants to stay home.” She also describes vasopressin as tempering the man’s sexual drive.

Vasopressin reinforces the father’s testosterone-promoted protective inclination regarding his mate and child, but tempers his aggression, making him more reasonable and less extreme. By promoting more rational and less capricious thinking, this hormone induces a sensible paternal role, providing stability as well as vigilance.

Prolactin and Behavior

Prolactin is released in all healthy people during sleep, helping to maintain reproductive organs and immune function. In the mother, prolactin is released in response to suckling, promoting milk production as well as maternal behaviors. Prolactin relaxes mother and, in the early months, creates a bit of fatigue during a nursing session so she has no strong desire to hop up and do other things.

Prolactin promotes caregiving behaviors and, over time, directs brain reorganization to favor these behaviors. Father’s prolactin levels begin to elevate during mother’s pregnancy, but most of the rise in the male occurs after many days of cohabitation with the infant.

As a result of hormonally orchestrated brain reorganization during parenthood, prolactin release patterns are altered. It has been shown that fathers release prolactin in response to intruder threats, whereas childless males do not. On the other hand, nursing mothers do not release prolactin in response to loud noise, whereas childless females do. In children and non-parents, prolactin surges are related to stress levels, so it is generally considered a stress hormone. In parents, it serves as a parenting hormone.

Elevated prolactin levels in both the nursing mother and the involved father cause some reduction in their testosterone levels, which in turn reduces their libidos (but not their sexual functioning). Their fertility can be reduced for a time as well. This reduction in sexual activity and fertility is entirely by design for the benefit of the infant, allowing for ample parental attention and energy. When the father is intimately involved with the infant along with the mother, there should be some accord between the desires of the two, and oxytocin and other chemicals provide for heightened bonding and non-sexual interest in each other, which serves to retain a second devoted caretaker for the infant.

Opioids and Rewards

Opioids (pleasure hormones) are natural morphine-like chemicals created in our bodies. They reduce pain awareness and create feelings of elation. Social contacts, particularly touch—especially between parent and child—induce opioid release, creating good feelings that will enhance bonding. Odor, taste, activity and even place preferences can develop as the result of opioid release during pleasant contacts, and eventually the sight of a loved one’s face stimulates surges. Opioid released in a child’s brain as a conditioned response to a parent’s warm hugs and kisses can be effective for helping reduce the pain from a tumble or a disappointment.

Parents “learn” to enjoy beneficial activities such as breastfeeding and holding, and infants “learn” to enjoy contact such as being held, carried and rocked, all as a response to opioid release. Babies need milk, and opioids are nature’s reward to them for obtaining it, especially during the initial attempts. The first few episodes of sucking organize nerve pathways in the newborn’s brain, conditioning her to continue this activity. This is the reason that breastfed babies sometimes have trouble if they are given bottles in the newborn nursery: Early exposure to bottles creates a confusing association of pleasure with both bottle nipples and the mother’s breast. In fact, any incidental sensations experienced during rocking, touching and eating that aren’t noxious can become part of a child’s attachment and will provide comfort. It could be the warmth of mother’s body, father’s furry chest, grandma’s gentle lullaby, a blanket or the wood-slatted side of a crib.

Prolonged elevation of prolactin in the attached parent stimulates the opioid system, heightening the rewards for intimate, loving family relationships, possibly above all else. Just as with codeine and morphine, tolerance to natural opioids can occur, which will reduce the reward level for various activities over time. But this is not a problem for attached infants and parents, because higher levels of oxytocin, especially when created through frequent or prolonged body contact, actually inhibit opioid tolerance, protecting the rewards for maintaining close family relationships. On the other hand, consuming artificial opioid drugs replaces the brain’s need for maintaining family contacts.

Once a strong opioid bonding has occurred, separation can become emotionally upsetting and, in the infant, possibly even physically uncomfortable when opioid levels decrease in the brain, much like the withdrawal symptoms from cocaine or heroin. When opioid levels become low, one might feel like going home to hold the baby or like crying for a parent’s warm embrace, depending on your point of view. Sometimes alternate behaviors are helpful. For instance, thumb-sucking can provide some relief from partial or total withdrawal from a human or rubber nipple and can even provide opioid-produced reminiscences for a time.

Norepinephrine and Learning

Breastfeeding also causes dopamine and its product, norepinephrine (adrenaline), to be produced, which help maintain some of the effects of the early bonding. They enhance energy and alertness along with some of the pleasure of attachment.

Norepinephrine helps organize the infant’s stress control system, as well as other important hormonal controls in accordance with the nature of the early rearing experiences. It promotes learning about the environment—especially learning by memorization that is carried out by oxytocin, opioids and other chemical influences.

Pheromones and Basic Instincts

How does the man’s body know to initiate hormonal changes when he is living with a pregnant female? How can an infant accurately interpret mother’s “odors” that adults often can barely detect? The answer is pheromones. Among other things, pheromones are steroid hormones that are made in our skin. Our bodies are instinctually programmed to react accordingly when we detect these pheromones around us.

Newborns are much more sensitive to pheromones than adults. Unable to respond to verbal or many other cues, they apparently depend on this primitive sense that controls much of the behavior of lower animals. Most likely, the initial imprinting of baby to odors and pheromones is not just a matter of preferring the parents’ odors but is a way nature controls brain organization and hormonal releases to best adapt baby to its environment. Baby’s earliest, most primitive experiences are then linked to higher abilities such as facial and emotional recognition. Through these, baby most likely learns how to perceive the level of stress in the caretakers around her, such as when mother is experiencing fear or joy. Part of an infant’s distress over separation may be caused by the lost parental cues about the safety of her environment. Of course, the other basic sensation an infant responds to well is touch, and coincidentally, body odors and pheromones can only be sensed when people are physically very near each other.

What the World Needs Now…

Infants universally cry when laid down alone. If we allow ourselves to listen, our neurons and hormones encourage us in the proper response. Babies are designed to be frequently fed in a fashion that requires skin-to-skin contact, holding and available facial cues. Beneficial, permanent brain changes result in both parent and infant from just such actions. Contented maternal behaviors grow when cues are followed. The enhancement of fatherhood is strongly provided for as well. A father’s participation encourages his further involvement and creates accord between father and mother. Frequent proximity and touch between baby and parents can create powerful family bonding, with many long-term benefits.

Sadly, over the last century, parents have been encouraged by industry-educated “experts” to ignore their every instinct to respond to baby’s powerful parenting lessons. Psychologists, neurologists and biochemists have now confirmed what many of us have instinctually suspected: that many of the rewards of parenthood have been missed along the way and that generations of children may have missed out on important lifelong advantages.

New Magazine Issue Advocates for Increased Support of Compassionate Infant-Feeding Choices

In honor of the millions of women who have come together throughout history to support one another in motherhood, Attachment Parenting International (API) is pleased to announce the latest edition of Attached Family magazine. This double “Voices of Breastfeeding” issue spotlights both the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome.

“This issue of the magazine has been a long time in the making,” said Rita Brhel, Editor of the Attached Family and API Publications Coordinator. “We wanted to create a resource that is helpful to all mothers, both those who were able to breastfeed their babies and those who were unable to.”

The “Voices of Breastfeeding” edition of Attached Family is divided into an “Advocating for Acceptance” issue that identifies the ever-growing movement of mothers inspired to campaign for society’s embrace of breastfeeding, and a “Meeting Challenges with Compassion” issue that recognizes that there are circumstances when breastfeeding is difficult, if not impossible, highlighting the importance of empathetic support for all infant-feeding choices.

“Ideally, I would have liked to have breastfed all three of my children,” Brhel said. “But Attachment Parenting International supports parents in all walks of life, including mothers who are unable to breastfeed, and I was able to learn how to meet my child’s attachment needs through sensitive responsiveness beyond breastfeeding.”

This edition of Attached Family was also made in appreciation of longtime magazines like Mothering, New Beginnings and Breastfeeding Today, which paved the way to widespread support for breastfeeding and Attachment Parenting conversations among mothers, and now fathers, and by extension, contributing to the breastfeeding movement that eventually influenced the research and medical communities.

“API is pleased to give a voice to our breastfeeding struggles, those related to society’s acceptance as well as those shared by mother and baby,” said Samantha Gray, Executive Director of Attachment Parenting International. “Emphasizing healthy attachment and relationship, it is natural that we speak up collectively to further advocacy efforts and gather together regularly to give personal support. Our contributors, led by Rita’s editorial vision and passion for breastfeeding support, have captured that perspective in this double issue.”

Scattered throughout the “Voices of Breastfeeding” edition of Attached Family are parent stories, project highlights and additional resources from around and beyond API, as well as the following features:

· “The Real Breastfeeding Story” detailing exactly how far industrial society has come in accepting breastfeeding, yet also how far we have yet to go, which includes a look at “Extended Nursing Around the World”

“This edition of Attached Family continues API’s goal of providing research-backed information in an environment of respect, empathy and compassion in order to support parents in making decisions for their families and to create support networks in their communities,” Brhel said.

Connecting with our children for a more compassionate world.

Attention API Members

Attachment Parenting International is grateful to those who contribute to its publications, including TheAttachedFamily.com. It is to be noted that API entertains a variety of perspectives and embraces opportunities to challenge and strengthen its API family. Please find what works for you, support and encourage, and leave the rest behind. For more on API’s perspective on parenting, visit the API website by clicking on the link in the Additional API Resources below.